术中超声判断肺癌淋巴结转移的研究

目的 评价术中超声(IUS)在肺癌手术中检出纵隔和肺门淋巴结的能力及其判断淋巴结转移的准确性。方法 对33例肺癌患者进行了术中超声俭查，逐区探查并记录纵隔和肺门淋巴结的数目、大小、部位，根据淋巴结的几何尺寸和声像特征预测其是否为转移，以手术淋巴结清扫和病理检查的结果为对照。结果 (1)IUS检出淋巴结的敏感度为83．6％(163／195)．阳性预告值为97．0％(165／168)。不同分区和淋巴结的大小对于检出率有影响。(2)IUS预测淋巴结转移的结果：以淋巴结几何尺寸为标准，其敏感度为70．3％，特异度为71．7％，准确率为71．2％，以声像特征为标准则分别为85．7％、75．0％、83．3％。结论 IUS是肺癌手术中探查和发现纵隔淋巴结的一种有效的方法。

DETECTION OF LYMPHATIC METASTASIS OF LUNG CANCER BY INTRAOPERATIVE ULTRASONOGRAPHY

Objective To evaluate the value of intraoperative ultrasonography (IUS) in detecting the lymph nodes in mediastinum and hilum during lung cancer surgery. Methods Lymph nodes were detected in every part of the mediastinum and hilum by IUS in 33 cases with lung cancer during surgery. The number, size and location of lymph nodes were recorded, and the metastasis to lymph nodes was predicted by the sonographic features and geometric measurement respectively. Mediastinum was explored and lymph nodes resection was performed in each case, and each resected lymph node was sent for pathological examination. Results The sensitivity of IUS in detecting lymph nodes in mediastinum and hilum was 83.6% (163/195) and the positive predictive value was 97.0%(165/168). The result of detecting lymph nodes with IUS was influenced by their location and size. The sensitivity, specificity and accuracy of IUS in diagnosing lymphatic metastasis with respect to geometric measurement were 70.3%, 71.7%, 71.2%, respectively, and were 85.7%, 75.0%, 83.3%, respectively, with respect to sonographic features. Conclusions IUS was an effective method for lung cancer surgery in detecting mediastinum lymph nodes.